The value of disease management - Approaching the industrialisation of modern medicine

Recent years have seen the beginning of an industrial revolution in healthcare delivery. Healthcare is being transformed from a cottage industry, in which each provider sets individual standards, to a quality-controlled enterprise with common, evidence-based standards of care. Disease management is fundamental to this transformation; it is based on the application of the industrial engineering principle of 'total quality management' to healthcare as 'continuous quality improvement'. As little evidence has been published in the peer-reviewed literature regarding the cost effectiveness of disease management, specific disease management programmes should be judged by the extent to which its design adheres to the principles of continuous quality improvement. Disease: management should, furthermore, be integrated into the overall activities of the healthcare system rather than being a carve-out offering. The true value of disease management is as a paradigm by which the healthcare system can re-engineer how it goes about its business - with clear goals, recognised standards and ongoing monitoring. The adoption of evidence-based best practice guidelines and the attendant reduction in practice variation will inevitably benefit millions of patients.